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  • 2022-RA-1595-ESGO The role of sentinel lymph node biopsy in the management of patients with endometrial atypical hyperplasia: a multicenter study

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Endometrial cancer
2022-RA-1595-ESGO The role of sentinel lymph node biopsy in the management of patients with endometrial atypical hyperplasia: a multicenter study
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  1. Andrea Rosati1,
  2. Virginia Vargiu2,
  3. Vito Andrea Capozzi3,
  4. Emilia Palmieri1,
  5. Alessandro Baroni1,
  6. Emanuele Perrone1,
  7. Francesco Cosentino2,4,
  8. Roberto Berretta3,
  9. Giovanni Scambia1,5 and
  10. Francesco Fanfani1,5
  1. 1Department Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  2. 2Department of Oncology, Gemelli Molise SpA, Campobasso, Italy
  3. 3Department of Medicine and Surgery, University of Parma, Parma, Italy
  4. 4Department of Medicine and Health Sciences ‘Vincenzo Tiberio’, Università degli studi del Molise, Campobasso, Italy
  5. 5Università Cattolica del Sacro Cuore, Rome, Italy

Abstract

Introduction/Background The role of sentinel lymph node mapping in patients with complex atypical hyperplasia (CAH) is a debated topic in literature and needs to be clarified.The aim of this study was to describe the surgical outcomes, intra-postoperative complications of patients with CAH undergoing a radical surgical staging with or without sentinel-lymph-node (SLN) biopsy, and to describe the incidence and histopathological features of endometrial cancer (EC) diagnosed in each group.

Methodology All patients with pre-operative diagnosis of CAH were retrospectively retrieved. Study population was subdivided based on surgical staging procedures in Group-1 (total hysterectomy) and Group-2 (total hysterectomy plus SLN-biopsy).

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Abstract 2022-RA-1595-ESGO Table 1

Results 460 patients were identified (Group-1:192, Group-2: 268).The surgical approach differed significantly between the two groups, with a higher rate of robotic procedures in Group 2 and laparoscopic procedures in Group 1 (28.7% vs 6.3% and 75.5% vs 63.1%, respectively, p <0.001).No disparities in surgical variables were registered between Group-1 and 2 regarding estimated blood loss and operative time (respectively: p=0.075, p=0.143).Furthermore, both severe and overall rate of intraoperative (IO) and postoperative complications did not significantly vary across Groups (respectively: no severe IO complications occurred, p=0.868, p=0.489, p=0.07).At final histopathological examination the incidence of EC was significantly higher in Group 2 (p<0.001).Considering only EC cases, the distribution of prognostic risk groups did not significantly vary within Groups (p=0.329), while in the overall series the most frequent risk class was Low (71.4%), followed by High-intermediate (11.1%), Intermediate (9.7%) and High (7.8%).The rate of understaging was 28.1% and the rate of overtreatment 39.2%.

Conclusion SLN dissection is a safe and not time-consuming procedure that can be proposed while counseling patients for radical treatment of CAH.During the decision-making process the 28.1% rate of understaging together with a non-negligible proportion of High-intermediate and High-risk classes should be balanced with a 39.2% ratio of overtreatment.

https://doi.org/10.1136/ijgc-2022-ESGO.349

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